X is for Xylitol Toxicity

X is for Xylitol Toxicity

A number of years ago, I received a telephone call while on-call. The person informed me that her dog ate a piece of chocolate cake. I asked some more specific questions: What size is your dog? How much chocolate cake did it get? Was it a cake made from a box or from a gourmet bakery? Etc. Based upon her answers, I informed the woman that the likelihood of her dog having any problems was minimal (pretty much zero) as it only took a small bite and it was a box mix which does not have much chocolate in it. The woman than said, “I don’t know if you know this, but chocolate is toxic to dogs.” I thanked her for the information, and yes, I was aware, but the toxicity is based on type of chocolate (milk chocolate is not as bad as dark chocolate which is not as bad as baker’s chocolate), size of the dog, and the amount of chocolate eaten (a bigger dog can eat more than a small dog with less complications). I told her what to watch for in case there were any problems and asked her to call again if she noticed any. There have been other times in my career that I have had a very different conversation when it comes to toxicity. In 2004, the conversations about toxicity started to grow as a new toxin emerged on the veterinary scene: Xylitol.

Xylitol used for baking (SocialAlex and www.mixedfitness.com)

Xylitol used for baking (SocialAlex and http://www.mixedfitness.com)

Xylitol is a chemical compound that is made most commonly from birch trees and is used as a sugar substitute. It is most commonly found in sugar-free gum, candies, and in many forms of toothpaste. Some people, especially diabetics, use it as a sugar substitute in cooking. Due to the slow absorption in people, there are very few side effects, although some people complain of diarrhea after ingestion of even small amounts. When reading labels you may also see xylitol listed as Eutrit, Kannit, Newtol, Xylite, Torch, or Xyliton.

In dogs there is a very fast absorption rate, often within 30 minutes, and signs and symptoms of xylitol poisoning can develop rapidly. That being said, since toxicity normally develops from eating the gum which is meant to be chewed, it can take up to 12 hours for symptoms to develop since dogs rarely chew and just swallow the gum. The most commonly seen sign is severe hypoglycemia (low blood sugar) that comes as a result of rapid release of insulin from the pancreas into the blood stream. If the dog’s blood sugar drops low enough, coma and death can occur rapidly as well. Other side effects include liver disease with secondary bleeding, liver failure, and death. Cows, goats, and rabbits also show a significant release of insulin in response to xylitol. At this time, it is unknown how cats respond to xylitol.

How much xylitol does it take to make a dog sick?

Spry sugar-free gum

We know that as little as 100 mg/kg (45 mg/lb) requires decontamination and monitoring, with dogs receiving more than this requiring supportive care. In the case of baking xylitol (the granulated form), 1 cup weights 190 grams. When it comes to gum and candy, the difficult part is that manufacturers do not always list how much xylitol is in their products. Estimates range from 0.9-1,000 mg per piece of xylitol containing gum. Clinically, we can see toxicity in a 20 pound (9 kg) dog with as little as 1 small piece of gum. Therefore, it is essential to contact your veterinarian (or veterinary emergency clinic) immediately upon knowledge or suspicion of ingestion of sugar-free products. If possible, have the packaging available when you speak with the veterinarian or bring it with you if going straight to a veterinary clinic or hospital. In the United States, you can contact the Pet Poison Hotline at 800-213-6680 or the ASPCA Poison Hotline at (888) 426-4435, although there is a fee associated with the call it may save you some money when going to the veterinarian.

What should I expect when I get to the veterinary clinic?

Photo courtesy of Sean94110 https://www.flickr.com/photos/sean94110/

Photo courtesy of Sean94110 https://www.flickr.com/photos/sean94110/

You should expect to have a history and complete examination performed. If your dog is not showing symptoms and the ingestion was recent, he or she may be given medication to induce vomiting which will hopefully remove the ingested substance from the stomach and then do appropriate diagnostics and supportive care. If your dog is already showing signs of toxicity, the veterinary team may obtain blood and urine samples and place an IV catheter. Blood tests should include chemistry, electrolytes, and complete blood count (CBC). They may also check clotting times (PT and aPTT) and fibrinogen levels, especially if there are already signs of bleeding. Once low blood sugar has been documented, then IV fluids containing dextrose will be started. Your dog may need to remain on IV fluids for 24-72 hours or until the blood glucose has stabilized. Multiple checks of glucose will be performed (usually only needing a few drops of blood) and liver values will also be monitored to make sure there is no worsening or liver disease.

If caught early in the process or if it is a mild case, the prognosis is generally very good. Waiting to seek medical attention until after symptoms start or in ingestion of large amounts of xylitol, prognosis worsens significantly.

Ways to prevent xylitol toxicity include not having xylitol containing products in the home or keeping them far out of reach of animals (which can be difficult if there are children in the home) and knowing what is in the products you have. Double check all products labeled as sugar-free.

Remember that although this can be fatal, it is usually treatable. What should you do if you suspect or know that your pet has been poisoned? Click HERE.

For a list of the Top 10 Pet Poisons of 2013 click HERE and for an alphabetical list of animal poisons click HERE.

Xylitol photo credit: SocialAlex at Photopin.com using Creative Commons Licenses

Spry photo credit: Katherine of Chicago at Photopin.com using Creative Commons Licenses

Dog photo credit: Sean94110 at Photopin.com using Creative Commons Licenses

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26 thoughts on “X is for Xylitol Toxicity

  1. I don’t think we have any Xylitol in the house, but that’s good to know. I’m laughing at the woman telling you chocolate is toxic! That does explain a lot, though. We had a small dog in the 90s who licked a little Hershey’s syrup that was in the trash and got really sick. Yet he ate a Goo Goo Cluster a few years later and showed no symptoms at all!

    Stephanie
    http://stephie5741.blogspot.com

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  2. Another great post and clever X word choice. I’m a vet tech tech and your first paragraph made me laugh, I can totally hear that woman telling you chocolate is toxic. Xylitol is one not many people know about so thanks for putting the information out there and for sharing the doses because I didn’t know that either! I’ve been enjoying your blog during the challenge!

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    • Thanks for the feedback. Since I don’t consider myself a writer, I have been trying to find ways to make my posts not so scientific and inject a little bit of humor – I still laugh when I think about that call! I was going to go a completely different direction and do XMRV, but since that is rather obscure and I spoke with someone about a month ago with a dog that had no idea about xylitol toxicity and she is dental hygienist, I figured it would be a good topic! I am glad you are enjoying the posts!

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  3. Wow what a fascinating blog you have. So much readily shared information to those who might benefit. I have a 21 year old cat who I love dearly. I don’t expect to have her around too much longer, but I’m very grateful to have had her this long.

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    • Thank you for the kind words. I am so thankful that you have had your kitty for so long. The oldest cat I have worked with was 24, she was a great girl. We even did a dental cleaning and extractions when she was 24, made the owners so happy when she ran around like a kitten again. Sadly, she died from cancer about 6 months later, but they were so pleased to have made that time easier on her!

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  4. Wow, I had no idea. Glad I read your post today. We don’t usually have artificial sweeteners in the house, but a friend of mine does and I’ll let her know. Thanks for the info and, thanks for dropping by my blog and commenting!

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  5. I have found calling Animal Poison Control for these cases to be amazingly helpful, especially with the gum. Poison control has databases that in some cases can tell us exactly how much xylitol is in each stick of gum of different brands and flavors. They can also be very helpful for treatment suggestions tailored to each case. Treating xylitol toxicity can be very scary and very costly. I had one lady once feed “a scoop” of cranberry sauce to each of five dogs in her household. The cranberry sauce was made with xylitol and every dog received a very dangerous dose and needed to be hospitalized. The treatment plan for five dogs was well over $5000 for the first 24 hours in the hospital. Yikes!

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    • EEK! Thanks for sharing, Melissa!! I love the poison control hotlines – Pet Poison Control always seems to be the most helpful for me and generally saves clients money if they call first (at least where I have practiced) and then come to the clinic with the case number. I have only had a couple xylitol cases and luckily was able to make them vomit and we were able to count out the sticks of gum to make sure there were none left, but they still got IV fluids for 12-24 hours. It is always hard when people don’t know what type of product was eaten though. I have had to call some manufacturers to try and get the xylitol content and even though it was an emergency situation, they wouldn’t give it to me. Very frustrating!

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      • Pet Poison is also good. They share the same databases, sometimes I felt like ASPCA was more thorough. My latest xylitol case ate a pack of Orbitz gum and the client was reluctant to call poison control and just wanted me to treat. I got the “why should I pay them when I need to be at the vet anyway and you should know what to do?” Well, I convinced them to call and it turned out the particular flavor of gum ingested did not have barely any xylitol and the dog didn’t need any treatment AT ALL! Saved the client quite a lot of money! 🙂

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      • I always tell people that yes, I am good at what I do, but poison control always has the latest information so we need to call them first with any toxicity. If the owner called, they just got the fee from them, if we called, we pay the fee, but the client paid a higher fee because we spend more time on the phone and going back and forth between owner and poison control. That is awesome that the dog didn’t need treatment. It is great when people actually listen to us.

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  6. As a long term dog owner very helpful info!
    PS when kids little we would leave a trail of chocolate eggs and ivariably the Westie would get one or two and the practise changed!

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    • I think as kids, we have all done such things! Luckily, we all learn that perhaps what we do as kids is not always ideal and we grow up. Wouldn’t it be great if we could still keep the wide-eyed innocence of youth though, the thrill of learning something new? Some things of childhood should be kept!

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  7. Wow, that’s really scary. Xylitol seems to be toxic to me too, so I don’t consume it at all. I only have cats, but your post is a good reminder to all pet owners to be careful to keep our food out of reach. Pets can (and do!) get into everything, just like kids. 🙂

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    • Thanks for commenting again 🙂 I hope the side effects are not too bad for you. I know many of the artificial sweeteners give my husband and I headaches and shakiness. I just need to work on decreasing my sugar intake!

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  8. Such a helpful post!
    I can’t remember where or when I heard that we are not meant to feed our dogs with “human food” because their “systems” are not designed to deal with it.
    So I don’t ever feed my dog from our meals. We give him dog food (a good quality… to my knowledge…) and dog biscuits etc. He’s NEVER eaten chocolate (well, I’m not really a choccie person, so that ruled it out…)
    I’m visiting on the eve of the last day, of this crazy yet exciting challenge… *waving*
    Writer In Transit

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    • I am very particular about when and how much I recommend people to give people food (some is not bad and in some cases can be good), although here in the US, most animals are obese, so they generally don’t need any more “extras” in their diets. This has been a crazy, yet exciting, challenge. I am not sure if I am happy or sad that it will be ending. I can say that I am proud of myself for not missing or being late on any posts (with the exception of one post where I accidentally scheduled it to post at 12:01 pm instead of 12:01 am and figured it out at 7:14 am).

      I hope to “see” you again! *waving*

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